POM-P Flashcards
what are the most recent POM-P/GSL switches?
- Amorolfine nail lacquer (GSL)
- Desogestrel (P)
- Estradiol (P)
- Fexofenadine (GSL)
- Naproxen (P)
- Orlistat (P)
- Mometasone Nasal spray (P)
- Maloff Protect
(Atovaquone/Proguanil) (P) - PPI’s
- Pantoprazole (P)
- Esomeprazole (GSL)
- Omeprazole (GSL)
- Sildenafil (P)
- Sumatriptan (P)
- Tamsulosin (P)
- Tranexamic Acid (P)
- Ulipristal acetate (P)
what is the indication for estradiol 10mch vaginal tablets?
Treatment of vaginal atrophy due to oestrogen deficiency in postmenopausal women
aged 50+, who have not had a period for at least 1 year, +/- uterus
* Vaginal atrophy: dryness, soreness, itching, burning, irritation, painful intercourse
what should the dose of estradiol 10mcg vaginal tablets be?
– Initial: one vaginal table daily for 2 weeks
– Maintenance: one vaginal tablet twice a week
* If symptoms return after break- maintenance
* If symptoms still not resolved initial then maintenance
– Switching from other topical oestrogen:
* If taking recommended dose >3 months, symptoms controlled, no health changes
– Benefit: can take 8-12 weeks
how should you administer estradiol 10mcg vaginal tablets?
– Intravaginal application using
– Open the blister pack at the plunger end.
– Insert the applicator in the vagina until resistance is met (8-10 cm).
– Release the tablet by pressing the plunger.
– Withdraw the applicator and discard
what are the contraindications for estradiol 10mcg tablets?
– Hypersensitivity or allergies to estradiol or any of the excipients
– Undiagnosed genital bleeding
– Untreated endometrial hyperplasia (thickening of the uterus)
– Women with an intact uterus previously treated with unopposed systemic oestrogens
– Angina, heart attack, ischaemic stroke (current, recent)
– Hx oestrogen dependent cancer: breast, ovarian, endometrial
– Hx venous thromboembolism
– Porphyria (blood disorder)
– Vaginal – untreated infection (unusual discharge, severe itching). Irregular bleeding
– Vulval dermatosis – change to colour/ texture
– Acute or previous liver disease- liver tests don’t return to normal
when should you refer someone presenting for estradiol tablets?
– No symptom improvement in 7 weeks
– <50 or
– menstruation <1 year ago
– Hx endometriosis/ endometrial hyperplaysia
how should you counsel someone on estradiol tablets?
- Side effects
– Headache; abdominal pain; vaginal discomfort,
discharge, bleeding; steroid dependent cancer - Seek urgent medical attention if:
– Jaundice or deterioration in liver function
– Significant increase in blood pressure
– New onset of migraine-type headache
– Pregnancy
what is the indication for desogestrel (hana/lovima)? what age can it be given to?
indication:
* Contraception in women of childbearing age.
* Age:
* Safety and efficacy under 18y not established
* Hana: 18+
* Lovima: “benefits and risks of supply to adolescents under 16 years
should be carefully considered”
what is the dose and the side effects of desogestrel?
- One daily
- Can be used whilst breastfeeding
- Side effects:
- Irregular bleed patterns, mood altered, headaches, nausea, acne,
breast pain/tenderness*, amenorrhoea, weight changes - Report severe abdominal/ chest pain, DVT, headaches
how should you initiate desogestrel?
Day 1 of period. If days 2-5 but will need to use an additional barrier method for first 7 days
how should you start a desogestrel pill after COC tablet/ patch?
No break: Start next day
After pill free period: 7 day barrier required
how should you start a desogestrel pill after a POP?
No break: start next day
how should you start desogestrel following miscarriage/ abortion?
ASAP or within 5 days, after- barrier required.
how should you start desogestrel following childbirth?
up to 21 days after birth. >= barrier required
how should you start desogestrel after EHC?
Levonorgestrel: Start straightaway and use an additional barrier method (e.g. condom) for 7 days.
Ulipristal: Wait 5 days after taking ulipristal and use an additional barrier method (e.g. condom). Then start desogestrel and continue using an additional barrier method for a further 7 days (12 days additional barrier method use in total).
what are the missed pill rules for desogestrel?
<12 hours late, take the missed tablet ASAP and take the next tablet at the
usual time, even if it leads to taking two tablets in one day.
* >12 hours late, take the forgotten tablet and take the next tablet at the
usual time, even if it leads to taking two tablets in one day. If more than one
tablet has been missed, only one of the missed tablets should be taken
immediately. An additional barrier method of contraception for the next 7
days.
* If vomiting occurs within 3-4 hours of tablet-taking, then the pill should be
considered ‘missed’
when is desogestrel contraindicated?
Known or suspected sex-steroid sensitive malignancies (breast, uterine, ovarian).
– Active venous thromboembolic disorder.
– Presence or history of severe hepatic disease as long as liver function values have not
returned to normal.
– Irregular vaginal bleeding.
– Hypersensitivity to the active substance or to any of the excipients
when should you refer someone for desogestrel?
– Significant interaction (Anti-convulsants, St John’s wort)
– Hx of thrombosis or breast cancer
– If the person has diabetes
– If the person has uncontrolled hypertension
– If the person experiences any serious side effects or signs and symptoms of adverse
effects e.g. depression, thrombosis, allergy, liver disease, breast cancer or ectopic
pregnancy
– If the person is due to have surgery or is immobile.
what is the indication/ dose for omeprazole?
– OTC omeprazole is indicated for the short-term relief of heartburn
symptoms associated with acid reflux in adults aged 18 yrs +
* Dose
– The dose is 20mg once daily for up to 14 days
– No improvement after 2 weeks refer to prescriber
when should you refer someone who presents for omeprazole?
– <18, >55 years new onset/ change in presentation
* >45 if recurrent GORD and taking OTC
– Red flags for gastric cancer:
* Dysphagia, unexplained weight loss, blood in stool or vomit, persistent vomiting,
epigastric mass, severe stomach pain, hx gastric ulcer
what drug interactions does omeprazole have?
- Omeprazole is metabolised by the liver through cytochrome P450 hence can delay the elimination of diazepam, phenytoin
and warfarin. - Due to the decreased intragastric acidity, the absorption of ketoconazole or itraconazole may be reduced during omeprazole treatment,
- Similarly, It may also alter the absorption of digoxin.
what are other PPIs available?
- Esomeprazole (GSL)
– Licensed for short term use up to 14 days for reflux in adults. - Pantoprazole 20mg OD (P)
– Up to 4 weeks, refer if no improvement after 2 weeks - Both 18+
- Same referral points as Omeprazole
- Lifestyle counselling
what is the indication for orlistat?
– Weight loss in adults (18+) who are overweight or obese (body
mass index >28kg/m2)
– Need to check BMI at each supply
what is the dose of orlistat?
– 60mg TDS immediately before, during or up to 1 hour after each
meal. If no meal/no fat miss tablet.
– Should be in conjunction with a low-fat diet
* Aid weight loss and minimise GI side effects
– Max 6 months treatment
